Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. Do not sell or share my personal information. CareFirst reserves the right to change this list at any time without notice. Independent licensees of the Blue Cross Association. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. %%EOF In the event of an emergency, members may access emergency services 24/7. Code Bundling Rationale 2017 Q3 CPT Codes, Code Bundling Rationale 2017 Q2CPT Codes, Code Bundling Rationale 2017 Q1CPT Codes, Code Bundling Rationale 2016 Q4CPT Codes, Code Bundling Rationale 2016 Q3CPT Codes, Code Bundling Rationale 2016 Q2CPT Codes, Code Bundling Rationale 2016 Q1CPT Codes, Code Bundling Rationale 2015 Q4CPT Codes, Code Bundling Rationale 2015 Q3CPT Codes, Code Bundling Rationale 2015 Q2CPT Codes, Code Bundling Rationale 2015 Q1CPT Codes, Code Bundling Rationale 2014 Q4CPT Codes, Code Bundling Rationale 2014 Q3CPT Codes, Code Bundling Rationale 2014 Q2CPT Codes, Code Bundling Rationale 2014 Q1CPT Codes, Code Bundling Rationale 2013 Q4CPT Codes, Code Bundling Rationale 2013 Q3CPT Codes, Code Bundling Rationale 2013 Q2CPT Codes, Code Bundling Rationale 2013 Q1CPT Codes, Code Bundling Rationale 2012 Q4CPT Codes, Code Bundling Rationale 2012 Q3CPT Codes, Code Bundling Rationale 2012 Q2CPT Codes, Code Bundling Rationale 2012 Q1CPT Codes, Code Bundling Rationale 2011 Q4CPT Codes, Code Bundling Rationale 2011 Q3CPT Codes, Code Bundling Rationale 2011 Q2CPT Codes, Code Bundling Rationale 2011 Q1CPT Codes, Code Bundling Rationale 2010 Q4CPT Codes, Code Bundling Rationale 2010 Q3CPT Codes, Code Bundling Rationale 2010 Q2CPT Codes, Code Bundling Rationale 2010 Q1CPT Codes, 1998-document.write(new Date().getFullYear()); BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. Forms and information to help you request prior authorization or file an appeal. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Providers should continue to verify member eligibility and benefits prior to rendering services. CareFirst does not guarantee that this list is complete or current. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), whichunderwrites or administersthe PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwritesor administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Musculoskeletal (eviCore): 800-540-2406. The site may also contain non-Medicare related information. These documents contain information about your benefits, network and coverage. Start by choosing your patient's network listed below. Forms and information about pharmacy services and prescriptions for your patients. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. The latest edition and archives of our monthly provider newsletter. CareFirst Medicare Advantage requires notification/prior authorization of certain services. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. Independent licensees of the Blue Cross Association. Please check your schedule of benefits for coverage information. State & Federal / Medicare. We encourage providers to use The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Future updates regarding COVID-19 will appear in the monthly Provider News publication. 2022 Standard Pre-certification list . HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. There are three variants; a typed, drawn or uploaded signature. Medical Clearance Forms and Certifications of Medical Necessity. Mar 1, 2022 In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. In Ohio: Community Insurance Company. For more information, please refer to the Medical Policy Reference Manual. Providers are responsible for verifying prior authorization requirements before services are rendered. Providers should call the prior authorization number on the back of the member ID card. FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Administrative. The clinical editing rationale supporting this database is provided here to assist you in understanding the We look forward to working with you to provide quality services to our members. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Information to help you maximize your performance in our quality programs. Forms and information about behavioral health services for your patients. Third-Party Liability (TPL) Forms. Independent licensees of the Blue Cross and Blue Shield Association. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. CoverKids. endstream endobj startxref Online - The AIM ProviderPortal is available 24x7. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. For your convenience, we've put these commonly used documents together in one place. Please refer to the criteria listed below for genetic testing. Please verify benefit coverage prior to rendering services. Contact will be made by an insurance agent or insurance company. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 494 0 obj <>stream Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. rationale behind certain code pairs in the database. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Anthem offers great healthcare options for federal employees and their families. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. This step will help you determine if prior authorization may be required for a specific member and service. CareFirst Commercial Pre-Service Review and Prior Authorization. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Learn about the NAIC rules regarding coordination of benefits. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Pharmacy Forms. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). Noncompliance with new requirements may result in denied claims. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. To view this file, you may need to install a PDF reader program. Some procedures may also receive instant approval. Details about new programs and changes to our procedures and guidelines. To get started, select the state you live in. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Fax medical prior authorization request forms to: 844-864-7853 Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. Most PDF readers are a free download. Select Patient Registration from the top navigation. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Please note: This change is not applicable to the members enrolled in the Mercy Co-worker Plan as they have a customized prior authorization list. To get started, select the state you live in. 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